MEDICARE: PROFESSIONAL PHARMACY II

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	22459	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2098411	OTHER		PK

General Provider Information

NPI Number	:	1891856969
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL PHARMACY II

Provider Business Mailing Address
First Line	:	2730 N STEMMONS FWY
Second Line	:	SUITE 813
City	:	DALLAS
State	:	TX
Zip	:	75207-2279
Country	:	US
Telephone Number	:	214-951-0133
Fax Number	:	214-951-0155

Provider Business Practice Location Address
First Line	:	1221 W AIRPORT FWY STE 111
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75062-6296
Country	:	US
Telephone Number	:	972-514-1277
Fax Number	:	972-514-1365

Authorized Official
Title or Position	:	OWNER/RPH
Name	:	PAMELA ASHU
Credential	:	BSPHARM
Telephone Number	:	214-765-9238

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	06/23/2015

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Directions to “PROFESSIONAL PHARMACY II ” Practice Location

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